Public-Private Mix tuberculosis control activities in private hospitals in Myanmar 03.08.2018

MMA PPM-TB Project Manager Dr Thet Naing Maung accepting the Best Paper Award for Health Systems Research on ‘Public-Private Mix tuberculosis control activities in private hospitals in Myanmar: providers' perspectives’ at the 46th Myanmar Health Research Congress, 2018

In collaboration with the National TB Programme (NTP), a study was carried out by the Myanmar Medical Association, Public-Private Mix Tuberculosis Project (MMA PPM TB), to identify issues around the TB diagnosis, process, and management system in private hospitals in Myanmar, and their linkage to NTP. The study concluded that, in order to reach the goals of the End TB Strategy, private hospitals needed to engage in Public-Private Mix TB control activities by establishing systematic linkages with NTP and other partners in the national response to TB.    

Public-Private Mix tuberculosis control activities in private hospitals in Myanmar: a study on providers' perspectives

In collaboration with the National TB Programme (NTP), a study was carried out by the Myanmar Medical Association, Public-Private Mix Tuberculosis Project (MMA PPM TB), to identify issues around the TB diagnosis, process, and management system in private hospitals in Myanmar, and their linkage to NTP. The study employed a cross-sectional survey, using structured questionnaires, to assess the hospitals’ structural profile and TB diagnostic facilities in 22 private hospitals, and to measure knowledge and management of TB among 143 clinicians. To complement the survey findings, qualitative information was gathered through 7 focus group discussions and 23 key informant interviews.   

Union Minister for Health and Sports H.E Dr Myint Htwe delivers the opening speech for the 45th Myanmar Health Research Congress
Union Minister for Health and Sports H.E Dr Myint Htwe delivers the opening speech for the 45th Myanmar Health Research Congress

Findings

In regard to the hospitals, 90.9% of all hospitals were found to be lacking hospital guidelines for TB control, and 95.5% had no reporting system to NTP in place. Moreover, knowledge of TB infection control administrative measures was poor, and 12 out of 14 laboratories were not using an external quality assurance system for sputum smear microscopy.  

The clinicians who participated in the survey included medical officers (MOs) (61.5%), general physicians (15.4%) and chest physicians (2.1%). Some 73.4% of clinicians were aware of the use of sputum examinations for diagnosis of presumptive adult TB patients compared to only 26.6% for the diagnosis of presumptive childhood TB patients.

Knowledge of GeneXpert testing was at 68.5%, and on the criteria for its use at 35%. In all, 57.3% were aware of the current practices for making a TB diagnosis and 14.7% of the process of treating TB patients. Knowledge of the use of chest X-ray and sputum microscopy were at 96.1% and 87.4%, respectively.  

Regarding differences among the different types of clinicians, all chest physicians were found to have correct knowledge, and to refer TB patients to NTP for treatment. Among general physicians and MOs, 90.9% of general physicians and 76.1% of MOs had correct knowledge, including TB evaluation with sputum examination for all adults, while 18.2% and 25% of general physicians and MOs respectively knew the number of sputum specimens required, and 18.2% and 3.4% respectively knew the timing of the three follow-up sputum examinations. 

Interview with a clinician
Interview with a clinician

Although all general physicians knew the treatment regimen for a new adult drug sensitive TB patient, 4.5% answered incorrectly on which drugs are used in initial phase. Moreover, 54.5% of general physicians and most pediatricians reported not referring TB patients for treatment.  

Among the qualitative findings, a number of issues were identified. These included that there was no specific financial and social support programme for TB management at private hospitals; there were limitations in missed dose tracing, as well as tracing of contacts and patients lost to follow-up; no TB case notification and outcome reports were being sent from private hospitals to NTP; and participants reported not receiving feedback from NTP on patients that they had referred there. 

Conclusions

The study concluded that, in order to reach the goals of the End TB Strategy, private hospitals needed to engage in Public-Private Mix TB control activities by establishing systematic linkages with NTP and other partners in the national response to TB. 

The study received the Best Paper Award for Health Systems Research at the 46th Myanmar Health Research Congress, held on 8–12 January 2018. The Myanmar Medical Association has been implementing the “Public-Private Mix TB Project” with support from the Global Fund since 2011 in Myanmar. 

You can read more about other publications by MMA  here.